Single-disease covers are being launched in response to customer demand. They cover both in-and-out patient expenses and are cheap, says Jacob, while fielding a wide range of questions pertaining to customers’ health insurance needs in an interview with ET.

Your company has just launched Dengue Care. Why should people go for these singledisease covers? Isn’t it more effective to buy a policy that covers a wide range of diseases?

Single-disease covers offer comprehensive coverage for that particular disease and serve as an add-on cover to regular health insurance policies. If you have dengue, your health insurance policy will only cover expenses for inpatient treatment. But Dengue Care also reimburses your outpatient bills. It also has a low premium of Rs 444.

As customers seek specialised products, I foresee a trend of specialised products in health insurance continuing for a long time to come. However, a basic health insurance product will always serve as a base to these special benefit plans.

What should be the ideal sum assured one should opt for a health cover?

The only rule of thumb while buying health insurance is to be adequately covered. Low coverage is even more dangerous than no coverage as it gives one a false sense of protection. When deciding on the sum assured, take into account the city of residence: healthcare services in Mumbai are more expensive than in Nasik. Also consider your life stage, whether you are married or single, and the extent of coverage you can afford.

Based on statistics, we believe that you should buy a family floater cover of Rs 10 lakh if you live in a tier 1 or 2 city, and Rs 5 lakh if you live in a tier 3 or 4 city. This should suffice for a family of two adults and one child. For an individual cover, the corresponding amounts would be Rs 5 lakh and Rs 3 lakh respectively. Consider your health status when deciding on the extent of cover.

Why does the premium remain the same in a life insurance policy but gets revised upward at regular intervals in a health policy?

Health insurance premium depends on factors like the insured’s age, health condition, medical inflation and so on. Since these factors are not constant and have a direct effect on the overall expenditure on healthcare, companies need to revise premium rates to ensure sustainability.

We revise premiums once in three-four years based on our claims experience in a particular policy. Any change in premium is done after thorough actuarial research and approval from the regulator.

What can a person do to lessen the pain of regular revision in premiums?

Maintain good health. If you do not make claims, you can earn handsome bonuses. This will allow you to increase your sum assured and keep pace with medical inflation.

What are the risks of depending on the health insurance cover provided by your employer?

Many employers are now doing away with cover for dependants from group covers, so employees should purchase personal health insurance policies for long-term cover for themselves and their families.

Such a policy will provide continuous coverage, even in times of job change, when the company’s cover ceases. You will also remain covered in case you decide to turn into an entrepreneur.

Should one buy another health insurance policy or will a top-up cover suffice to supplement the employer’s policy?

It is always better to have a personal health insurance policy. Top-up plans are well suited for individuals with group cover or with policies that have a low sum insured. Apollo Munich’s Optima Super is the only plan in the market that serves as a top-up cover while you are employed and can be switched to a full-fledged plan at the time of retirement or when the need is felt, no questions asked.

What risks does a person run when he buys a cover based entirely on the premium? Which are some of the other parameters that should be considered?

When buying a health insurance policy for the first time, we advise people not to choose the lowest-priced policy, as it is not always the best in terms of coverage, inclusions and benefits.

Customers should compare health insurance policies by the extent of coverage benefits each one provides. Factors like sublimits, co-payment, claim related limits, exclusions, hospital network and claim track record should form the basis of comparison.

Which are the key service parameters on which an insurance provider should excel?

The key parameters are customer servicing, claim settlement and wide hospital network. Customers can judge an insurer based on their initial experience with the company. If the company officials are responsive, transparent, understand the customer’s needs and offer a product suited to that need, it reflects on the overall culture of the company. IRDA also publishes claim settlement ratios of all companies on its website.

Many of the diseases suffered by senior citizens are treated at home. There is no hospitalisation, so these diseases are not covered by regular health policies. Are companies thinking of a solution to this problem?

Due to lack of consolidated data on treatments taken at home, it becomes challenging for insurers to innovate. However, the industry should see more options for senior citizens in the years to come.

What innovations has your company brought to the industry? Which are some of the policy features that were hard to get a few years earlier but are now standard features in health policies?

Before we entered the segment in 2007, health insurance products had sub-limits, there was lack of lifelong cover, and claims processes were slow. Easy Health, our firstgeneration product, was the first to offer lifelong cover, no sub-limits and portability. Gradually, all insurers started offering these features. Eventually IRDA made these features mandatory in 2011.

Apollo Munich was also the first to bring in multiplier and restore benefits under Optima Restore. Today these features have also become common.

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